Individuals, Populations & Clinical Practice

Question 1

What is the definition of population health?

Answer 1

population health is an approach that aims to improve physical and mental health outcomes, promote wellbeing and reduce health inequalities across an entire population

Question 2

What is the NHS Long Term plan?

Answer 2

an ambitious 10-year vision for healthcare in England

over the next 10 years, health and care will change significantly

the new service model includes increasing care in the community and a focus on population health, prevention and reducing health inequalities

Question 3

What are the 4 components of population health?

Answer 3

• the wider determinants of health
• an integrated health and care system
• our health behaviours and lifestyles
• the places and communities we live in, and with

Question 4

What is the most important driver of health?

What are some examples?

Answer 4

the wider determinants of health are the most important driver of health

in addition to income & wealth, these determinants include:

• education
• housing
• transport & leisure

Question 5

What is the second most important driver of health?

What are examples of these?

Answer 5

health behaviours and lifestyles

this includes smoking, alcohol consumption, diet and exercise

Question 6

What is the definition of the “social determinants of health”?

Answer 6

it is a term used to describe the social and environmental conditions in which people are born, grow, live, work and age, which shape and drive health outcomes

Question 7

What are the main examples of the wider determinants of health?

Answer 7

• agriculture and food
• water and sanitation
• unemployment
• social and community networks
• living and working conditions
• housing
• education
• work

Question 8

What is shown in these UK population pyramids?

How has the life expectancy changed in the last 100 years and why?

Answer 8

over the past 100 years, england has made an escape from poor health and short life expectancy

this is largely due to improvements in the wider determinants of health, such as sanitation, improved living standards and the establishment of the welfare state

inequalities in health have persisted, but the population as a whole has seen increases in life expectancy

Question 9

What is shown by the 1950 pyramid:

• having a wider base?
• being more triangular in shape?
• being shorter?

Answer 9

• 1950 has a wider base showing a greater birth rate
• 1950 is more triangular in shape showing a greater death rate
• 1950 pyramid is shorter showing a lower life expectancy
• overall the UK population is averagely older in 2020 than it was in 1950

Question 10

How has life expectancy at birth for males and females changed in the last 30 years?

In what areas may it have declined?

Answer 10

• the stalling of life expectancy growth since 2011 is clear for both men and women
• for the poorest 10% of women in the UK, life expectancy has not stalled but actually declined
• the health gap between wealthy and deprived areas has grown
• living in a deprived area of the North East is worse for your health than living in a similarly deprived area in London, to the extent that life expectancy is nearly 5 years less

Question 11

What is shown in this graph?

How is it an example of a social gradient?

Answer 11

it shows the relationship between local authority deprivation and healthy life expectancy at birth

on average, healthy life expectancy at birth differs by 12 years between the most and least deprived local authorities for men and women

this is a social gradient because health inequalities are only relevant for the most vulnerable or socially excluded

Question 12

What is the Marmot Review?

How does this describe health inequalities?

Answer 12

it shows that since 2010 there have been detoriations in health and widening inequalities in England

it describes evidence showing that health inequalities do not arise by chance or simply due to unhealthy behaviour or genetic makeup

the differences in health largely reflect inequalities in the social determinants of health

Question 13

How does this graph show a social gradient in health?

(obesity prevalence by deprivation in England, year 6 pupils, 2017/18)

Answer 13

there is a strong relationship between deprivation and obesity

severe obesity prevalence was over 4 times as high in the most deprived areas than the least deprived areas

Question 14

What is the difference between equality and equity as shown in this image?

Answer 14

• equality would involve giving everyone the same size box to stand on to improve their lines of sight
  
  • this involves treating everyone equally
• equity involves each person being given a box to stand on that would enable them to have a clear view over the fence

Question 15

Why is the difference between health equality and health equity important to public health?

Answer 15

to ensure that resources are directed appropriately

for these reasons, providing the same type and number of resources to all is not enough

in order to reduce the health disparities gap, the underlying issues and individual needs of underserved and vulnerable populations must be effectively addressed

Question 16

Why is it important to recognise the sociological factors that contribute to illness?

Answer 16

doctors need to be able to recognise the sociological factors that contribute to illness, the course of the disease and the success of the treatment and apply these to the care of patients

this includes issues relating to health inequalities and the social determinants of health and the effects of poverty and affluence

Question 17

How can you understand how the social and economic factors are impacting a patient’s health?

Answer 17

by building a trusting and respectful relationship with all your patients and taking a full social history

then you can provide information and take action to address these

e.g. writing a support letter to housing , referring to employment programes and connecting patients to advice about benefits so that the root causes of ill health are being tackled

Question 18

As a health professional, how can you be an advocate for your local community?

Answer 18

as a health professional, we have a strong and powerful voice to act as an advocate, not just for individual patients, but also for the community and the general population

e.g. for the COVID-19 epidemic, there is concern that vulnerable migrants who have no right to free healthcare in the UK will be at particular risk

Question 19

What are the different methods of health promotion?

Answer 19

• medical or preventative
• behaviour change
• educational
• empowerment
• social change

Question 20

What does the behaviour change approach focus on?

What is success dependent upon?

Answer 20

the behaviour change approach focuses on individuals - attitudes, behaviour, responsibility, choice

the success is dependent on the individual

Question 21

What would be the FRAMES approach to designing an intervention to promote behaviour change?

Answer 21

F - Feedback:

• e.g. on the person’s risk of having alcohol problems
• cover the potential harm they may cause

R - Responsibility:

• change is the person’s responsibility

A - Advice:

• provision of clear advice when requested

M - Menu:

• what are the options for change?
• e.g. trying alternative activities to drinking, recognising personal cues for drinking

E - empathy:

• the approach is warm, reflective and understanding

S - Self-efficacy:

• the final component of effective brief interventions is to encourage patients’ confidence that they are able to make changes in their substance use behaviour
• people who believe that they are able to make changes are much more likely to do so

Question 22

What is the definition of a brief intervention?

Answer 22

an intervention designed to promote behaviour change

Question 23

What is the aim of an educational approach to health promotion?

Answer 23

it enables individuals to make informaed choices, by providing information and knowledge

it aims to avoid persuasion

Question 24

What have recent studies shown about women from the Black and Asian Minority Ethnic (BAME) backgrounds and their likelihood to attend cervical screening?

Answer 24

they are less likely to attend cervical screening and GP practices wth high proportions of ethnic minority patients have lower coverage

this is putting this population at increased risk of cervical cancer and is a concerning health inequality

Question 25

How has the issue that women from the BAME background are less likely to attend cervical screening been addressed?

Answer 25

* running regular education sessions at the GP practice for female BAME patients * providing food and children's activities so that having young children isn't a barrier for attending * having interpreters in several languages to translate and providing written information in multiple languages * there was a lack of awareness of cervical cancer in this community and a lack of understanding about screening, which could be tackled through an educational approach

Question 26

What is the definition of an empowerment approach to health promotion?

Answer 26

empowerment is the process of giving confidence, skills and power to individuals / communities to identify and address their concerns

Question 27

Who are community health champions? What is the aim of their work?

Answer 27

volunteers who establish groups to meet local needs they draw on their own local knowledge and life experience to motivate and support family, friends, neighbours and work colleagues to take part in healthy social activities the health champion programmes aim to address health inequalities by involving people from disadvantaged groups or those at risk of poor health

Question 28

What is meant by a social change approach to health promotion?

Answer 28

this involves changing society, not individuals physical and social environment changes lead to healthier choices this needs public and political support i.e. changes in legislation e.g. minimum unit pricing on alcohol

Question 29

What are the 4 stages of disease prevention?

Answer 29

* primordial prevention * primary prevention * secondary prevention * tertiary prevention

Question 30

What is primordial prevention?

Answer 30

acting to prevent risk factors emerging in the first place rather than just act to modify risk factors once they are present this is "addressing the causes of the cause"

Question 31

What are adverse childhood experiences? What have UK studies seen links to?

Answer 31

UK studies have shown strong relationship between adverse childhood experiences and homelessness as well as early sexual behaviour, drug and alcohol use, mental health and reported suicidal behaviour or self harm ACEs which are stressful life events between birth and 18 years of age including neglect, domestic abuse in the family, parental drug or alcohol problems

Question 32

What type of prevention would be used to prevent the issues caused by adverse childhood experiences?

Answer 32

primordial prevention would involve a public health approach to addressing ACEs, through supporing families and reducing domestic abuse and neglect

Question 33

What is primary prevention? What are examples relating to a young homeless person injecting heroin?

Answer 33

action to modify existing risk factors to prevent development of disease in healthy people * altering risky behaviours - e.g. advising against injecting, smoke drugs instead, do not use alone due to risks of overdose, start opiate substitution treatment * protecting from pathogenic disease - immunisation against the bloodborne viruses Hep B and Hep C

Question 34

What is secondary prevention?

Answer 34

actions to detect disease early to minimse the emergence of symptoms and/or complications

Question 35

What is an example of secondary prevention relating to the COVID-19 pandemic and patients with mental health?

Answer 35

vulnerable patients (e.g. due to mental health) might not be able to access health care when needed if they were to contract COVID-19 support workers to do daily screening for all people in hostels (i.e. asymptomatic) using thermometers and oxygen saturation probes

Question 36

What are the benefits to secondary prevention / screening?

Answer 36

* might detect a problem before the patient is aware of one * could allow early isolation and treatment * could identify patients at risk of COVID-19 (or other disease) for diagnostic testing * could prevent deaths

Question 37

What are the risks associated with secondary prevention / screening?

Answer 37

* could produce false positives * could produce false negatives * could expose support workers to infection * could spread infection more between patients

Question 38

What is the definition of screening?

Answer 38

testing of a population for a condition who do not have recognised symptoms

Question 39

What are the risks associated with false positives and false negatives in screening / secondary prevention?

Answer 39

**false positives:** * increased anxiety * altering staff to someone who is well, calling out the GP and using up limited resources unnecessarily **false negatives:** * false reassurance * some diseases develop symptoms quickly, so they could be fine on testing morning but unwell by the evening but think that everything is okay

Question 40

What is the definition of tertiary prevention?

Answer 40

actions to improve quality of life and reduce symptoms in established disease aims to minimise impairment and reduce the impact of long-term conditions

Question 41

What are the different modes of disease transmission?

Answer 41

* direct physical contact * indirect contact * droplet * airborne * vehicle * vector borne

Question 42

How are communicable diseases spread among people?

Answer 42

communicable diseases spread from one person to another, or from an animal to a person the spread often happens via airborne viruses or bacteria, but also through blood and other bodily fluid

Question 43

What are examples of diseases that are spread through direct physical contact? What precautions can be taken?

Answer 43

direct physical contact (body surface to body surface) between infected individual and susceptible host e.g. influenza virus, infectious mononucleosis, chlamydia precautions include hand hygiene, masks and condoms

Question 44

What are examples of diseases spread through indirect contact? What precautions can be taken?

Answer 44

infectious agent is deposited onto an object or surface and survives long enough to transfer to another person who subsequently touches the object e.g. RSV, norovirus, rhinovirus precautions - sterilising instruments, disinfecting surfaces and toys in school

Question 45

How are diseases spread via droplets? Which diseases are spread this way and what precautions can be taken?

Answer 45

via coughing or sneezing or during suctioning (in healthcare) droplets are relatively large (\> 5 um) and can be projected up to about one metre examples are meningococus, pertussis, scarlet fever precautions are masks and isolating case

Question 46

What is airborne transmission? What are examples of diseases that are spread this way and precautions that can be taken?

Answer 46

transmission via aerosols (airborne particles \< 5um) that contain organisms in droplet nuclei or in dusts e.g. measles, chickenpox precautions are masks, negative pressure rooms in hospitals

Question 47

What is vehicle transmission? What diseases are spread in this way and what are some precautions?

Answer 47

a single contaminated source spreads the infection (or poison) e.g. food-borne outbreak from an infected batch of food precautions include normal safety and disinfection standards

Question 48

What are examples of vector-borne diseases? What precautions can be taken?

Answer 48

transmission by insect or animal vectors examples include mosquitoes (malaria vector) and ticks (lyme disease vector)

Question 49

How can respiratory infections be transmitted? What are the different names depending on droplet size?

Answer 49

respiratory infections can be transmitted through droplets of different sizes when the droplet particles are **\> 5-10 um** in diameter, they are referred to as **respiratory droplets** when they are **\< 5um** in diameter, they are referred to as **droplet nuclei**

Question 50

When does droplet transmission occur? How?

Answer 50

droplet transmission occurs when a person is in close contact (within 1 m) with someone who has respiratory symptoms (e.g. coughing and sneezing) they are at risk of having their mucosae (mouth and nose) or conjunctive (eyes) exposed to potentially infective respiratory droplets transmission may also occur through fomites in the immediate environment around the infected person

Question 51

Why is airborne transmission different from droplet transmission?

Answer 51

airborne transmission refers to the presence of microbes within droplet nuclei, which are generally considered to be particles \< 5um in diameter, can remain in the air for long periods of time and be transmitted to others over distances greater than 1m

Question 52

What are examples of infection prevention precautions?

Answer 52

* hand hygiene * personal protective equipment (PPE) * decontaminating equipment * isolation / quarantine * disinfection * education

Question 53

When should hand hygiene be used?

Answer 53

it is the single most important part of infection control hand washing before any contact with patients, after any activity that contaminates the hands, after removing protective clothing, after using the toilet and before handling food

Question 54

What is the difference between an epidemic and a pandemic?

Answer 54

**epidemic:** * a sickness that spreads among a population at a particular time **pandemic:** * afflicts "all peoples" * an epidemic occurring worldwide, or over a very wide area, crossing international boundaries and usually affecting a large number of people

Question 55

What is the definition of incubation period?

Answer 55

the time from exposure to the causative agent until the first symptoms develop and is characteristic for each disease agent

Question 56

What is meant by the infectious period?

Answer 56

the period during which an infected person can transmit a pathogen to a susceptible host people may be infectious before symptoms develop or when only mild, so the host does not feel unwell

Question 57

What is meant by virulence?

Answer 57

the ability of a microorganism to cause disease in the host

Question 58

What is the primary aim of vaccination? What are the other benefits?

Answer 58

* primary aim of vaccination is to protect the individual who receives the vaccine * vaccinated individuals are less likely to be a source of infection to others this reduces the risk of unvaccinated individuals being exposed to infection

Question 59

What is meant by herd immunity?

Answer 59

individuals who cannot be vaccinated will still benefit from the routine vaccination programme herd immunity is achieved when a large enough proportion of the population is immune to an infection that it cannot spread effectively and dies out

Question 60

What is the definition of immunity? What are the 2 different types?

Answer 60

immunity is the ability of the human body to protect itself from infectious disease innate immunity is non-specific and is present from birth acquired immunity is generally specific to a single organism or group of closely related organisms

Question 61

What are the two basic mechanisms for acquiring immunity? How are they achieved?

Answer 61

**active immunity:** * protection that is produced by an individual's own immune system * can be acquired by natural disease or by vaccination * vaccines generally provide immunity similar to that provided by the natural infection, but without the risk from the disease or its complications **passive immunity:** * protection provided from the transfer of antibodies from immune individuals, most commonly across the placenta

Question 62

How does Covid-19 show health inequalities?

Answer 62

people in poorer socio-economic circumstances are more likely to have chronic conditions, putting them at higher risk of COVID-19 associated mortality people in poorer socio-economic circumstances can also be more exposed to infection

Question 63

What are some ways in which people in poorer socio-economic circumstances are more exposed to COVID-19 infection?

Answer 63

* 2 million americans lack running water at home and Native American households are 19 times more likely than white households to lack indoor plumbing * the lack of guaranteed paid sick days for many low income workers may cause people to continue working when they should be self-isolating * african americans are dying from covid-19 in disproportionate numbers * live in closer proximity to each other and are more likely to experience overcrowding * financially poorer people are more likely to experience unemployment and further financial insecurities and are more vulnerable to labour market changes

Question 64

What diseases cannot be prevented? Why is health prevention important in diseases that can be prevented?

Answer 64

some diseases, such as those we are born with or inherit through our genes, cannot be prevented many causes of ill health are preventable in total, over half of the attributed burden of poor health and early death can be linked to behavioural, social and environmental factors that can be changed before they lead to diseases which need medical treatment

Question 65

What are the different levels of factors that affect the nation's health?

Answer 65

* the nation's health is partly the result of the quality of the health or social care we receive * it also depends on the social and economic environment in which we are born, grow up, live, work and age, as well as the decisions we make for ourselves and our families most experts agree these are more important than health and social care in ensuring longer, healthier lives

Question 66

How can health promotion & inequality be tackled at the individual and clinical care level?

Answer 66

* think not only about the biomedical issue of the individual patient, but also understanding the bigger picture * helping with individual lifestyle and social issues * e.g. working out behaviour changes for a patient drinking dangerous levels of alcohol, or referring a patient to support services

Question 67

How can health inequality and promotion be tackled at the community and national level?

Answer 67

* helping a community by educating about disease prevention (e.g. smear project) * empowering communities to set up their own solutions, suh as the health champions * healthcare providers have a powerful voice which can be used to drive changes in national policy to help patients * e.g. the alcohol minimum unit price campaign * e.g. petition to allow free access to NHS care for vulnerable migrants who are not currently eligible